LATE DIRECT ANGIOPLASTY IN PATIENTS WITH MYOCARDIAL-INFARCTION AND FLUCTUATING CHEST PAIN

Myocardial infarctions may be associated with reduced but persistent blood flow to the infarct zone. We developed clinical criteria to select patients likely to have persistent perfusion to the infarct zone in the setting of acute myocardial infarction. Twenty-four consecutive patients with fluctuating pain and/or ST segment elevation who presented within 24 hours of the onset of infarction were studied with coronary angiography followed by direct percutaneous transluminal coronary angioplasty. Sixty-seven percent of patients had residual flow to the infarct territory. Eighteen patients had repeat angiography on day 9.4 +/- 4.1, and all arteries were patent (21% +/- 12% stenosis). Ejection fraction had risen from 50.0% +/- 15% to 54.0% +/- 14% (p < 0.05). At follow-up (9.1 +/- 4.6 months), one patient died of noncardiac causes, and five redeveloped angina and underwent repeat procedures. Patients with fluctuating symptoms and/or ST segments are likely to have residual flow to the infarct zone, and late angioplasty may improve ventricular function in this group.